Method of using a volar bone plate on a fracture

ABSTRACT

A volar fixation system includes a plate intended to be positioned against the volar side of the radial bone. The plate includes threaded holes for receiving fasteners which lock relative to the plate.

CROSS-REFERENCE TO RELATED CASES

This application is a continuation of U.S. Ser. No. 13/789,959, filedMar. 8, 2013, which is a continuation of U.S. Ser. No. 12/823,738, filedJun. 25, 2010 and now issued as U.S. Pat. No. 8,403,967, which is acontinuation of U.S. Ser. No. 11/181,354, filed Jul. 14, 2005 and nowabandoned, which is a continuation of U.S. Ser. No. 10/762,695, filedJan. 22, 2004 and now abandoned, which is a continuation-in-part of U.S.Ser. No. 10/315,787, filed Dec. 10, 2002 and now issued as U.S. Pat. No.6,706,046, which is a continuation-in-part of U.S. Ser. No. 10/159,611,filed May 30, 2002 and now issued as U.S. Pat. No. 6,730,090, which is acontinuation-in-part of U.S. Ser. No. 09/735,228, filed Dec. 12, 2000and now issued as U.S. Pat. No. 6,440,135, which is acontinuation-in-part of U.S. Ser. No. 09/524,058, filed Mar. 13, 2000and now issued as U.S. Pat. No. 6,364,882, and is a continuation-in-partof U.S. Ser. No. 09/495,854, filed Feb. 1, 2000 and now issued as U.S.Pat. No. 6,358,250, the complete disclosures of which are herebyincorporated by reference herein.

BACKGROUND OF THE INVENTION

1. Field of the Invention

This invention relates broadly to surgical devices. More particularly,this invention relates to a bone fixation system, and particularly to afixation system adapted to fixate a distal radius fracture.

2. State of the Art

Referring to FIG. 1, a Colles' fracture is a fracture resulting fromcompressive forces being placed on the distal radius 10, and whichcauses backward displacement of the distal fragment 12 and radialdeviation of the hand at the wrist 14. Often, a Colles' fracture willresult in multiple bone fragments 16, 18, 20 which are movable and outof alignment relative to each other. If not properly treated, suchfractures result in permanent wrist deformity. It is therefore importantto align the fracture and fixate the bones relative to each other sothat proper healing may occur.

Alignment and fixation are typically performed by one of severalmethods: casting, external fixation, interosseous wiring, and plating.Casting is non-invasive, but may not be able to maintain alignment ofthe fracture where many bone fragments exist. Therefore, as analternative, external fixators may be used. External fixators utilize amethod known as ligamentotaxis, which provides distraction forces acrossthe joint and permits the fracture to be aligned based upon the tensionplaced on the surrounding ligaments. However, while external fixatorscan maintain the position of the wrist bones, it may nevertheless bedifficult in certain fractures to first provide the bones in properalignment. In addition, external fixators are often not suitable forfractures resulting in multiple bone fragments. Interosseous wiring isan invasive procedure whereby screws are positioned into the variousfragments and the screws are then wired together as bracing. This is adifficult and time consuming procedure. Moreover, unless the bracing isquite complex, the fracture may not be properly stabilized. Platingutilizes a stabilizing metal plate typically against the dorsal side ofthe bones, and a set of parallel pins extending from the plate into theholes drilled in the bone fragments to provide stabilized fixation ofthe fragments. However, the currently available plate systems fail toprovide desirable alignment and stabilization.

SUMMARY OF THE INVENTION

It is therefore an object of the invention to provide an improvedfixation and alignment system for a Colles' fracture.

It is another object of the invention to provide a volar fixation systemwhich desirably aligns and stabilizes multiple bone fragments in adistal radial fracture to permit proper healing.

In accord with these objects, which will be discussed in detail below, avolar fixation system is provided which generally includes a T-shapedplate intended to be positioned against the volar side of the radialbone, a plurality of bone screws for securing the plate along anon-fractured portion of the radial bone, and a plurality of bone pegswhich extend from the plate and into bone fragments of a Colles'fracture.

The plate is generally a T-shaped plate defining an elongate body, ahead portion angled relative to the body, a first side which is intendedto contact the bone, and a second side opposite the first side. The bodyportion includes a plurality of countersunk screw holes for theextension of the bone screws therethrough. The head portion includes aplurality of threaded peg holes for receiving the pegs therethrough.According to a first embodiment, the peg holes are preferablynon-linearly arranged. According to a second embodiment, the peg holesare preferably linearly arranged. In either embodiment, the peg holesare positioned increasingly distal in a medial to lateral directionalong the second side. According to a preferred aspect of the invention,axes through the holes are oblique relative to each other, and arepreferably angled relative to each other in two dimensions. The pegshaving a threaded head and a relatively smooth cylindrical shaft.

The system preferably also includes a guide plate which temporarily sitson top of the volar plate and includes holes oriented according to theaxes of the peg holes for guiding a drill into the bone fragments at therequired orientation. The volar plate and guide plate are alsopreferably provided with mating elements to temporarily stabilize theguide plate on the volar plate during the hole drilling process.

In use, the volar plate is positioned with its first side against thevolar side of the radius and bone screws are inserted through the bonescrew holes into the radius to secure the volar plate to the radius. Thebone fragments are then aligned and the guide plate is positioned on thesecond side of the volar plate. A drill, guided by guide holes in theguide plate, drills holes into the bone fragments, and the guide plateis then removed.

The pegs are then inserted through the peg holes and into the holes inthe bone, and the heads of the pegs are threadably engaged in the volarplate. The volar fixation system thereby secures the bone fragments intheir proper orientation.

Additional objects and advantages of the invention will become apparentto those skilled in the art upon reference to the detailed descriptiontaken in conjunction with the provided figures.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is an illustration of an extremity subject to a Colles' fracture;

FIG. 2 is a top volar view of a right hand volar fixation systemaccording to a first embodiment of the invention;

FIG. 3 is a side view of a bone peg according to the first embodiment ofthe volar fixation system of the invention;

FIG. 4 is a side view of a bone screw of the volar fixation system ofthe invention;

FIG. 5 is a side view of the right hand volar plate of the volarfixation system according to the first embodiment of the invention;

FIG. 6 is a front end view of the right hand volar plate of the volarfixation system according to the first embodiment of the invention;

FIG. 7 is an exploded side view of the right hand volar plate and guideplate according to the first embodiment of the fixation system of theinvention;

FIG. 8 is a side view of the guide plate positioned on the right handvolar plate to provide drill guide paths in accord with the invention;

FIG. 9 is an illustration of the first embodiment of the volar fixationsystem provided in situ aligning and stabilizing a Colles' fracture;

FIG. 10 is a top volar view of a left hand volar fixation systemaccording to the second embodiment of the invention;

FIG. 11 is a lateral side view of the left hand volar fixation systemaccording to the second embodiment of the invention;

FIG. 12 is a bottom view of the left hand volar fixation systemaccording to the second embodiment of the invention;

FIG. 13 is an enlarged side elevation of a bone peg according to thesecond embodiment of the volar fixation system of the invention;

FIG. 14 is a proximal end view of the bone peg of FIG. 13;

FIG. 15 is first partial top view of the head portion of the left handvolar plate according to the second embodiment of the volar fixationsystem of the invention;

FIGS. 16-19 are section views across line 16-16, 17-17, 18-18, and19-19, respectively in FIG. 15;

FIG. 20 is second partial top view of the head portion of the left handvolar plate according to the second embodiment of the volar fixationsystem of the invention; and

FIGS. 21-24 are section views across line 21-21, 22-22, 23-23, and24-24, respectively in FIG. 20.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

Turning now to FIGS. 2 through 4, a first embodiment of a volar fixationsystem 100 for aligning and stabilizing multiple bone fragments in aColles' fracture generally includes a substantially rigid T-shaped plate102 intended to be positioned against the volar side of the radial bone,a plurality of preferably self-tapping bone screws 104 for securing theplate 102 along a non-fractured portion of the radial bone, and aplurality of bone pegs 108 which extend from the plate 102 and into bonefragments of a Colles' fracture.

Referring to FIGS. 2, 5 and 6, more particularly, the T-shaped plate 102defines a head portion 116, an elongate body portion 118 angled relativeto the head portion, a first side 120 which is intended to contact thebone, and a second side 122 opposite the first side. The first side 120at the head portion is preferably planar, as is the first side at thebody portion. As the head portion and body portion are angled relativeto each other, the first side preferably defines two planar portions.The angle Ø between the head portion 116 and the body portion 118 ispreferably approximately 18° and bent at a radius of approximately 1.00inch (FIG. 5). The distal edge 121 of the head portion 116 is preferablyangled proximally toward the medial side at an angle α, e.g., 5°,relative to a line P, which is perpendicular to the body portion. Thehead portion 116 preferably has a width of 0.913 inch and a greatestproximal-distal dimension (i.e., from the corner of angle α to the bodyportion) of approximately 0.69 inch, and the body portion preferably hasa width of 0.375 inch and a length of 1.40 inches. The plate 102preferably has a thickness of approximately 0.098 inch. The plate 102 ispreferably made from a titanium alloy, such as Ti-6A-4V.

The body portion 118 includes three preferably countersunk screw holes124, 126, 128 for the extension of the bone screws 104 therethrough. Thefirst screw hole 124 has a center preferably 0.235 inch from the end ofthe body portion, the second screw hole 126 has a center preferably0.630 inch from the end of the body portion, and the third screw hole128 is preferably generally elliptical (or oval) and defines foci-likelocations at 1.020 inches and 1.050 inches from the end of the bodyportion. The head portion 116 includes four threaded peg holes 130, 132,134, 136 for individually receiving the pegs 108 therethrough. Accordingto a first preferred aspect of the first embodiment of the invention,the peg holes 130, 132, 134, 136, preferably 0.100 inch in diameter, arepreferably non-linearly arranged along the head portion 116, and areprovided such that the adjacent peg holes are provided further distallyin a medial to lateral direction along the second side. Moreparticularly, according to a preferred aspect of the first embodiment ofthe invention, the peg holes are preferably arranged along a paraboliccurve, with the center of peg hole 130 located approximately 0.321 inchproximal line P and approximately 0.719 inch medial of the lateral edge137 of the head portion, the center of peg hole 132 locatedapproximately 0.296 inch proximal line P and approximately 0.544 inchmedial of the lateral edge 137, the center of peg hole 134 locatedapproximately 0.250 inch proximal line P and approximately 0.369 inchmedial of the lateral edge 137, and the center of peg hole 136 locatedapproximately 0.191 inch proximal line P and approximately 0.194 inchmedial of the lateral edge 137.

In addition, according to a second preferred aspect of the firstembodiment of the invention, the peg holes define axes A₁, A₂, A₃, A₄which are oblique (not parallel) relative to each other, and morepreferably are angled in two dimensions (medial/lateral andproximal/distal) relative to each other; i.e., the pegs once insertedinto the peg holes are also angled in two dimensions relative to eachother. More particularly, the first axis A₁ of the first peg hole 130(that is, the most proximal and medial peg hole) is preferably directednormal to the first side 120 of the head portion 116. The axis A₂ of theadjacent peg hole 132, i.e., the second axis, is preferably angledapproximately 1-7° distal and lateral relative to the first axis A₁, andmore preferably approximately 2.5° distal and lateral relative to thefirst axis A₁. The axis A₃ of the peg hole 134 laterally adjacent thesecond peg hole 132, i.e., the third axis, is preferably angledapproximately 7-13° distal and lateral relative to the first axis A₁,and more preferably approximately 10° distal and lateral relative to thefirst axis A₁. The axis A₄ of the peg hole 134 laterally adjacent thethird peg hole 132, i.e., the fourth axis, is preferably angledapproximately 10-30° distal and lateral relative to the first axis A₁,and more preferably approximately 20° distal and lateral relative to thefirst axis A₁. The second side of the head portion 116, distal of thepeg holes 130, 132, 134, 136 is preferably beveled.

Referring back to FIG. 3, the pegs 108, preferably approximately 0.872inch in length, each have a threaded head 138 adapted to threadablyengage the threads about the peg holes 130, 132, 134, 136, and have arelatively smooth non-threaded cylindrical shaft 140. The shafts 140 arepreferably approximately 0.0675 inch in diameter and 0.765 inch inlength. Such dimensions permit the pegs to adequately support the bonefragments such that the bone is able to heal correctly. The pegs 108 arealso preferably made from titanium alloy, and may be coated in aceramic, e.g., titanium nitride, to provide a bone interface which willnot adversely affect bone healing.

Turning now to FIGS. 7 and 8, the system 100 preferably also includes aguide plate 146 which temporarily sits on the second side 122 of thevolar plate 102 and includes guide holes 148, 150, 152, 154 (illustratedin overlapping section in FIG. 8) oriented according to the axes A₁, A₂,A₃, A₄ of the peg holes for guiding a drill into the bone fragments atthe required orientation. That is, the guide holes together with the pegholes define a drill guide path along the axes with sufficient depth toaccurately guide a drill (not shown) to drill holes at the desired pinorientations. The volar plate 102 and guide plate 146 are alsopreferably provided with mating elements, such as a plurality of holes156, 158 on the second side of the volar plate (FIG. 2), and a pluralityof protuberances 160 on the mating side of the guide plate (FIG. 7), totemporarily stabilize the guide plate on the volar plate during the holedrilling process.

Referring to FIGS. 2 through 9, in use, the volar plate 102 ispositioned with its first side 120 against the volar side of the radius.Bone screws 104 (either self-tapping or inserted with the aid ofpre-drilled pilot holes) are inserted through the bone screw holes 124,126, 128 into the radius bone 10 to secure the volar plate 102 to theradius. The bone fragments 16, 18, 20 are then aligned with the radius10. Next, the guide plate 146 is positioned on the second side of thevolar plate. A drill, guided by a guide path formed by the peg holes andthe guide holes, drills holes into and between the bone fragments 16,18, 20 (and possibly also a portion of the integral radius, dependingupon the particular location and extent of the fracture), and the guideplate is then removed. The pegs 108 are then inserted through the pegholes 130, 132, 134, 136 and into the holes drilled into the fragments,and the heads of the pegs are threadably engaged in the volar plate. Thepegs 108, extending through the oblique-axis peg holes 130, 132, 134,136, are positioned immediately below the subchondral bone of the radiusand support the bone fragments for proper healing. The volar fixationsystem thereby secures the bone fragments in their proper orientation.

Referring to FIGS. 10-12, a second embodiment of a volar plate 210,substantially similar to the first embodiment (with like parts havingnumbers incremented by 100) and used in substantially the same manner asthe first embodiment is shown. The plate 210 preferably has a length ofapproximately 2.35 inches, which is approximately 0.35 inch greater thanin the first embodiment. This additional length accommodates an extrabone screw hole 229 in the body of the volar plate such that the volarplate preferably includes four bone screw holes 224, 226, 228, 229. Theadditional bone screw in screw hole 229 increases plate stability overthe three holes of the first embodiment. The plate 210 preferably tapersin thickness from the body portion 218 to the head portion 216. Apreferred taper provides a proximal body portion 218 thickness ofapproximately 0.098 inch and head portion 216 thickness of approximately0.078 inch. The taper decreases the thickness of the head portion 216relative to the body such that the weight of the volar plate is reducedand an improved tendon clearance is provided. The distal edge of thehead portion 216 has an increased taper (preferably approximately 60°relative to a line normal to the head) to a distal edge 221. The edge221 is broken (i.e., made blunt) to prevent irritation or disturbance tothe surrounding anatomy.

The head portion 216 includes four threaded peg holes 230, 232, 234, 236for individually receiving pegs 208 therethrough (FIGS. 13 and 14), anda guide hole 256 for alignment of a guide plate. According to apreferred aspect of the second embodiment of the invention, the pegholes 230, 232, 234, 236, preferably 0.100 inch in diameter, arepreferably linearly arranged along the head portion 216, and areprovided such that the adjacent peg holes are provided further distallyin a medial to lateral direction along the first and second sides.Referring to FIG. 15, more particularly, according to a preferreddimensions of the second embodiment of the invention, the center of peghole 230 is located approximately 0.321 inch proximal line P andapproximately 0.750 inch medial of the lateral edge 237 of the headportion, the center of peg hole 232 is located approximately 0.306 inchproximal line P and 0.557 inch medial of the lateral edge 237, thecenter of peg hole 234 is located approximately 0.289 inch proximal lineP and approximately 0.364 inch medial of the lateral edge 237, and thecenter of peg hole 236 is located approximately 0.272 inch proximal lineP and approximately 0.171 inch medial of the lateral edge 237. As such,the distance from each of the peg holes to the distal edge 221 of thevolar plate is relatively greater than in the first embodiment, andprovides a preferred alignment with respect to the tapered distal edge221.

Referring to FIGS. 15-24, in addition, as in the first embodiment, thepeg holes define axes A₁, A₂, A₃, A₄ which are oblique relative to eachother, and more preferably are angled in two dimensions (medial/lateraland proximal/distal) relative to each other; i.e., the pegs 208 onceinserted into the peg holes are also angled in two dimensions relativeto each other. More particularly, as in the first embodiment, the firstaxis A₁ of the first peg hole 230 is preferably directed normal (FIGS.16 and 21) to the first side 220 of the head portion 216. The axis A₂ ofpeg hole 232 is preferably angled approximately 1-7° distal (FIG. 17)and approximately 1-7° lateral (FIG. 22) relative to the axis A₁, andmore preferably approximately 2.5° both distal and lateral relative toaxis A₁. The axis A₃ of peg hole 234 is preferably angled approximately7-13° distal (FIG. 18) and approximately 7-13° lateral (FIG. 23)relative to axis A₁, and more preferably approximately 10° both distaland lateral relative to axis A₁. Axis A₄ of the peg hole 234 ispreferably angled approximately 10-30° distal (FIG. 19) andapproximately 10-30° lateral (FIG. 24) relative to axis A₁, and morepreferably approximately 20° both distal and lateral relative to axisA₁.

Referring to FIGS. 13 and 16-19, each of the peg holes has a countersunkportion 270, 272, 274, 276, respectively, for receiving the head 238 ofpeg 208. Countersunk portions 270, 272 are each preferably approximately0.030 inch deep and threaded according to the head of the pegs, asdescribed below. Countersunk portion 274 is preferably approximately0.042 inch deep and likewise threaded. Countersunk portion 276 ispreferably approximately 0.056 inch deep and also threaded. Therespective depths of the countersunk portions are adapted to betteraccommodate the heads 238 of the pegs 208 relative to the respectiveaxes of the peg holes.

Referring to FIGS. 13 and 14, the pegs 208, preferably approximately0.872 inch in length, each have a threaded head 238 adapted tothreadably engage threads about the peg holes 230, 232, 234, 236, andhave a relatively smooth non-threaded cylindrical shaft 240. The heads238 preferably include a no. 5 thread 280 at a count of 44 per inch. Inaddition, the heads 238 are rounded and include a hex socket 282 tofacilitate stabilized threading into the peg holes. This designaccommodates the reduced thickness of the volar plate at the headportion 216. The shafts 240 are preferably approximately 0.0792 inch (2mm) in diameter and 0.765 inch in length. Such dimensions permit thepegs to adequately support the bone fragments such that the bone is ableto heal correctly. The pegs 208 are also preferably made from titaniumalloy, and may be ‘tiodized’ to provide a strong finish which does notadversely affect bone healing.

There have been described and illustrated herein embodiments of a volarfixation system and a method of aligning and stabilizing a Colles'fracture. While particular embodiments of the invention have beendescribed, it is not intended that the invention be limited thereto, asit is intended that the invention be as broad in scope as the art willallow and that the specification be read likewise. Thus, whileparticular materials for the elements of the system have been disclosed,it will be appreciated that other materials may be used as well. Inaddition, while a particular numbers of screw holes in the volar platesand bone screws have been described, it will be understood anothernumber of screw holes and screws may be provided. Further, fewer screwsthan the number of screw holes may be used to secure to the volar plateto the radius. Also, fewer or more peg holes and bone pegs may be used,preferably such that at least two pegs angled in two dimensions relativeto each other are provided. Moreover, while in the first embodiment itis preferred that the peg holes lie along a parabolic curve, it will beappreciated that they can lie along another curve. In addition, while aparticular preferred angle between the head portion and body portion hasbeen disclosed, other angles can also be used. Furthermore, whileparticular distances are disclosed between the peg holes and line P, itwill be appreciated that the peg holes may be provided at otherdistances relative thereto. Moreover, while particular preferredmedial/lateral and proximal/distal angles for the peg hole axes has beendisclosed, it will be appreciated that yet other angles may be used inaccord with the invention. Also, while a right-handed volar plate isdescribed with respect to the first embodiment, and a left-handed volarplate is described with respect to the second embodiment, it will beappreciated that each embodiment may be formed in either a right- orleft-handed model, with such alternate models being mirror images of themodels described. In addition, aspects from each of the embodiments maybe combined. It will therefore be appreciated by those skilled in theart that yet other modifications could be made to the provided inventionwithout deviating from its spirit and scope as claimed.

What is claimed is:
 1. A method of stabilizing a fracture of a distalradius bone, the distal radius bone having subchondral bone that definesan articular surface with a concave curvature, the method comprising: a)providing or obtaining a rigid volar plate, the volar plate having aproximal body portion and a distal head portion, each of the bodyportion and the head portion including a bone contacting first surfaceand an opposite second surface, the head portion angled upward withrespect to a plane containing the body portion when the bone contactingfirst surface of the body portion is facing downward, the head portionincluding at least three first holes arranged in a generally medial tolateral direction, each of the at least three first holes defining arespective fixed central axis that is at a defined angle, each definedangle being at a different number of degrees from the other of the atleast three first holes, wherein a first hole of the at least threefirst holes has a central axis that is oriented parallel to a linenormal to a plane containing the head portion, a third hole of the atleast three first holes has a central axis that is angled at 7 to 13degrees relative to the central axis of the first of the at least threefirst holes, and a second hole of the at least three first holes has acentral axis that is situated at an angle between an angle of thecentral axis of the first hole and an angle of the central axis of thethird hole, and the body portion includes a plurality of second holes;b) positioning the bone contacting first surface of the body portionagainst the volar side of the radius bone; c) inserting at least onebone screw through at least one of the second holes and into the radiusbone to secure the volar plate against the volar side of the radiusbone; d) reducing the fracture; e) inserting each peg of a firstplurality of pegs into a corresponding one of the at least three firstholes in the head portion and into the volar side of the radius bone,each peg having a threaded head; and f) threadedly coupling the threadedhead of each peg of the first plurality of pegs with the correspondingone of the at least three first holes of the head portion of the platesuch that a shaft of each peg of the first plurality of pegs extendsimmediately below the subchondral bone of the radius bone and is axiallyfixed relative to the head portion of the plate, wherein the shaft ofeach peg of the first plurality of pegs extends divergently relative tothe other pegs from the bone contacting first surface of the plate inboth a medial-lateral direction and a proximal-distal direction, andwherein at least the at least three pegs and the head portion of thebone plate cooperate to form a stabilizing construct for the subchondralbone that conforms to the concave curvature of the articular surface. 2.The method according to claim 1, wherein: the second of the first holesis angled at 1 to 7 degrees relative to the first hole of the firstholes.
 3. The method according to claim 2, wherein: the first holesincludes a fourth hole, the third hole located between the second holeand the fourth hole, and the fourth hole is angled at 10 to 20 degreesrelative to the first hole of the first holes.
 4. The method accordingto claim 1, further comprising: before inserting each peg of the firstplurality of pegs, drilling into the radius bone to define bone holesfor the shafts of each peg of the first plurality of pegs.
 5. The methodaccording to claim 4, wherein: the drilling is performed through aplurality of guide holes disposed in a guide plate situated above thesecond surface of the plate, each of the guide holes having a bore axiscoaxial with a respective one of the fixed central axes.
 6. The methodaccording to claim 1, wherein: the volar plate includes four firstholes.
 7. A method of stabilizing a fracture of a distal radius bone,the distal radius bone having subchondral bone that defines an articularsurface with a concave curvature, the method comprising: a) providing orobtaining a rigid volar plate, the volar plate having a proximal bodyportion and a distal head portion, each of the body portion and the headportion including a bone contacting first surface and an opposite secondsurface, the head portion angled upward with respect to a planecontaining the body portion when the bone contacting first surface ofthe body portion is facing downward, the head portion including fourfirst holes arranged in a generally medial to lateral direction, each ofthe four first holes defining a respective fixed central axis that is ata defined angle, each defined angle being at a different number ofdegrees from the other of the four first holes, wherein a first hole ofthe four first holes is oriented parallel to a line normal to a planecontaining the head portion, a fourth hole of the four first holes isangled at 10 to 30 degrees relative to the first hole, and each of thesecond hole and third hole of is situated at an angle between an angleof the first hole and an angle of the fourth hole, and the body portionincludes a plurality of second holes; b) positioning the bone contactingfirst surface of the body portion against the volar side of the radiusbone; c) inserting at least one bone screw through the second holes andinto the radius bone to secure the volar plate against the volar side ofthe radius bone; d) reducing the fracture; e) inserting each peg of aplurality of pegs through a corresponding one of the four first holes inthe head portion and into the volar side of the radius bone, each peghaving a threaded head; and f) threadedly coupling the threaded head ofeach peg of the plurality of pegs with the corresponding one of the fourfirst holes in the head portion of the plate such that a shaft of eachpeg of the plurality of pegs extends immediately below the subchondralbone of the radius bone and is axially fixed relative to the headportion of the plate, wherein the shaft of each peg of the plurality ofpegs extends divergently relative to the other pegs from the bonecontacting first surface of the plate in both a medial-lateral directionand a proximal-distal direction, wherein at least the plurality of pegsand the bone plate and cooperate to form a stabilizing construct for thesubchondral bone that conforms to the concave curvature of the articularsurface.
 8. The method according to claim 7, wherein: the second hole isangled at 1 to 7 degrees relative to the first hole.
 9. The methodaccording to claim 7, further comprising: before inserting the pluralityof pegs, drilling into the radius bone to define bone holes for theshafts of the plurality of pegs.
 10. The method according to claim 9,wherein: the drilling is performed through a plurality of guide holesdisposed in a guide plate situated above the second surface of theplate, each of the guide holes having a bore axis coaxial with arespective one of the fixed central axes of the four first holes.